HomeMy WebLinkAboutNotarized permit applicationII All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
o�
Permit Number:
Building Permit Application
P/anning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial
CBDG Funding
PROPOSED IMPROVEMENT LOCATION:
Address: 701 Anita Street, Fort Pierce, FL 34982
Property Tax ID #: 3403-331-0006-000-5
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Electrical Service Change
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical
Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 3,928.53
OWNER/LESSEE:
Name Scotto, Anthony
Address: 701 Anita Street
City: Fort Pierce
Zip Code: 34982
Phone No.
Fax:
_Gas Piping
_Sprinklers
_Shutters
Residential
(Affidavit required)
_Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors
Utilities: _Sewer _Septic Building Height:
State: FL
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: Lazaro Y. Lego
rburo
Pitch
Company: America Statewide
Electrical Contractor
Address: 9571 NW24 ST
City: Sunrise
E- Zip Code: 33322 Fax.
Phone No (786)718-9398
E-Mail Lazaro@americastatewide.com
State or County License EC13009593
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HQVC is $7,500 or more, a RECORDED Notice of Commencement is required.
State: FL
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone. Zip: Phone:
----•-�•./ .....�.. n.,�,� vr� Hrr�uvll :Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
All
Signature of O er/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA ( _
COUNTY OF
Sworn to (or affirmed) and subscribed before me of ZPhysical Presence or Online Notarization
this day of"j1ty�tX' 20�L by
Name of person maklpg statement.
Personally Known OR Produced
T
\of Identification Producedo
Identification
(Signature of Notary Public- State of Florida)
Commission No
(Seal)
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
ev �—
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
�� rcM, Notary Public State of Florida
�+, Donna Perez
y c_ My Commission GG 169538
'? Aa Expires 12/19/2021
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW